Resurrection 2030 Style: Reanimating the Brain?

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Tom Tomlinson, PhD

In April, an intriguing study drew a lot of media attention… and a swarm of bioethicists.

Reported in the New York Times and other media outlets, the study by Zvonimir Vrselja and colleagues used a preservative solution and other ingredients to mimic blood flow in the disembodied brains of four pigs (presumed dead), beginning four hours after the pigs had been slaughtered. They discovered that neurons and other brain cells had resumed metabolic activity, and that individual neurons could carry a signal. (For a lay-friendly account, see Reardon 2019.)

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Image description: a photo of a cross section of the human brain. Image source: Carlos Lorenzo/Flickr Creative Commons.

This may be a line of research with tremendous potential. At the modest end the range, it could lead to discovering ways to prevent or reduce irreversible brain damage and death, supplementing or improving techniques already in use, such as hypothermia protocols.

But at the other end, it raises the prospect of reanimating parts of the brain that have “died”; or maybe the whole brain itself. Could raising the dead become common-place in another decade—no longer a miracle?

Could the brain dead be raised from the dead?

It might seem the answer to this question is yes. Following the Uniform Laws Commission recommendation, Michigan like all other states allows that death can be declared under two conditions:

An individual who has sustained either of the following is dead:
(a) Irreversible cessation of circulatory and respiratory functions.
(b) Irreversible cessation of all functions of the entire brain, including the brain stem.

If Vrselja and other researchers eventually develop the ability to reanimate a whole brain, and inside a skull rather than a vat, would this make whole brain death always reversible? At least so long as the rest of the body is functional enough to sustain the brain?

It might seem the answer is “yes.” The reanimated brain would have a full complement of neurons, capable of communicating with one another, and presumably then capable of the consciousness found in any healthy human brain. The functions of the brain would have been restored.

Presuming this is possible, such a prospect raises tremendous challenges to the ethical conduct of research leading up to such an achievement, which is a focus of concern for Farahany and colleagues. We might be creating or experimenting on brains (both human and non-human) capable of consciousness, and perhaps of suffering, but with no means of communicating that to the researchers.

But would the achievement really mean that whole brain death would no longer be an acceptable criterion for death?

I think the answer is no. Whole brain death marks the death of the person, not merely the death of the brain. And it’s the death of the person that matters—to that person, and to those around them.

It will in one sense be “my” brain that has been reanimated, and it will be occupying my body. But it will be “my” brain only in the sense of being causally continuous with my brain when I was still in my senses.

It most certainly will no longer be me. Assume that my brain has in fact died, with all or most of its cells and synapses no longer functioning. On what basis could my consciousness, preferences, memories, and many characteristic failings be recovered? Consciousness is most certainly not located in any specific part of the brain, or any particular type of neuron. It is a global, network phenomenon. With the death of my brain, my network has gone down.

The brain that is recovered may have the capacity to build a network of its own. But it won’t be mine.

Yes, they may be able to revive Porky the Pig’s brain one day. But it won’t be the Porky we know.

Tom Tomlinson photoTom Tomlinson, PhD, is a Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, June 6, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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What does it mean to declare brain death in the clinical setting?

No Easy Answers in Bioethics logoWhat does it mean to declare brain death in the clinical setting? How does the language we use surrounding death complicate these situations? What beliefs and philosophies exist regarding what constitutes the death of a person?

Episode 11 of No Easy Answers in Bioethics is now available! This episode features Center for Ethics and Humanities in the Life Sciences faculty members Dr. Devan Stahl and Dr. Tom Tomlinson. They discuss the above questions and more from both clinical ethics and philosophical perspectives. They go over the history of how brain death came to be defined in the United States, and discuss some cases in the news from recent years.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics—clinical ethics, evidence-based medicine, health policy, medical education, neuroethics, shared decision-making, and more. Episodes are hosted by H-Net: Humanities and Social Sciences Online.

A Brain Dead Little Girl Raises Some Big Questions

Bioethics-in-the-News-logoThis post is a part of our Bioethics in the News series. For more information, click here.

By Tom Tomlinson, Ph.D.

Starting a couple of weeks before Christmas, tragic news about Jahi McMath hit the media, and has scarcely abated since. Jahi is a 13-year-old girl who suffered a cardiac arrest and massive brain bleed following a routine tonsillectomy. She was declared whole brain dead on December 13 at Children’s Hospital and Research Center in Oakland, California. Her parents have been fighting ever since to prevent withdrawal of the ventilator and other interventions that have been sustaining her body, and succeeded in getting a series of court injunctions to prevent Children’s Hospital from removing “life support.”

As of this writing (January 22), Jahi is still on the machines and has been transferred to an undisclosed facility for continued care, despite the indisputable fact that a person who has suffered whole brain death is legally dead in all 50 states.

Predictably, bioethicists have been interviewed to offer their opinions about the case, and those opinions have been uncompromising—Jahi is not just brain dead, she is plain dead. Since there is no obligation to provide “life” support or any other medical treatment to a dead person, Children’s Hospital would have been fully within its rights to withdraw that treatment once Jahi was declared dead.

Laurence McCullough, bioethicist at Baylor College of Medicine, is quoted as saying that “There are no ethical issues in the care of someone who is brain-dead, because the patient is now a corpse . . . orders should have been immediately written to discontinue all life support. . . . The family should have been allowed to spend some time with the body if they wished. And then her body should have been sent to the morgue. That is straightforward. There is no ethical debate about that.”

Echoing similar comments imputed to Arthur Caplan (NYU Langone Medical Center) in the same article, McCullough is reputed to have said that “‘brain death’ is no different than any other sort of death: A brain-dead person is no longer alive. The term simply describes how the death was determined.”

McCullough and Caplan are right about the law. There is no difference between a person who is declared dead because his brain will no longer work, and a person declared dead because his heart and lungs have irreversibly stopped working. They are equally “dead,” legally speaking.

But in other respects brain death is different than other sorts of death. To begin with, brain-dead is not stone cold dead. When the whole brain has died, including the brain stem, the most important vital function that’s lost is the signal to breathe. But a ventilator can fill the lungs with air, providing oxygen to the rest of the body, even if the patient can no longer breathe on her own. Since the heart can operate relatively independently of the brain, a brain-dead person on a ventilator can have a heartbeat, might be warm and soft to the touch, and might have normal color. Brain-dead patients on ventilators don’t look like corpses. And, depending on a variety of factors, a brain-dead body might be successfully maintained for months—even enough time to bring a fetus to term—a factor in the case of another brain dead patient in Texas.

Given what they are probably seeing and feeling, then, it is completely understandable why Jahi’s parents believe their eyes rather than the doctors. From their perspective, the ventilator is keeping their daughter alive, not preserving a corpse. It wouldn’t be surprising if their discussions with the medical staff encouraged that idea. The very term “life support” creates a cognitive dissonance when applied to the brain dead patient who is allegedly dead. Encouraging the parents to agree to withdrawal of the ventilator because “The machine is the only thing keeping her alive” sends a similar mixed message. Even something like “Her condition is hopeless; there is nothing more we can do” suggests the ventilator is a kind of treatment that’s not going to prevent the patient’s death. The question whether it can prevent something presumes it hasn’t yet occurred.

In a study I did many years ago, experienced ICU physicians and nurses, who all understood the concept of brain death, and believed that brain-dead patients were legally dead, commonly used these sorts of expressions (Tomlinson, 1990). I suspect they are still commonly used, because a conversation about withdrawing hopeless treatment is much simpler and more familiar to all involved than an explanation of why a patient with a beating heart is dead.

So how can a person with a beating heart be dead? The answer is anything but straightforward.

Should we say—as many have about Jahi—that sooner or later her body will begin to deteriorate and her heart will stop? This is true enough, but all it really proves is that brain death is invariably terminal on anyone’s understanding of “dead.”

Should we say that if it weren’t for the ventilator, Jahi’s breathing and heartbeat would have stopped once her brain died? Yes, this is true. With the death of the brain, spontaneous respiration stops, and the heart stops very soon thereafter. The brain orchestrates the vital functions, and so the death of the brain spells the permanent loss of the vital functions. But this is not quite accurate. The death of the brain spells the end of the spontaneous vital functions. Why can’t we say that the ventilator is substituting for the function previously performed by the brain stem, and so keeping the patient alive by artificial means?

Enough already! Shouldn’t we just say that death is not really about the loss of the vital biological functions, or about the brain’s role in supporting them. It’s about the death of the person. The death of Jahi’s brain is the absolutely 100% accurate sign that she—the conscious person—will never return. Whether her heart keeps beating doesn’t matter. She’s gone.

This is a very attractive idea. After all, what does death mean to me, from the personal point of view, if not the end of my human experience? Whatever may continue after that doesn’t affect me in the least. If we accept this view, however, we will have to struggle with what to think about those persons whose brains still support respiration and heartbeats, but not conscious awareness. Was Terri Schiavo dead for the 14 years she was in a persistent vegetative state, with no awareness of herself or her environment, according to the neurologists who examined her? Just as dead as Jahi McMath is now?

“Dead” was a pretty simple notion once upon a time. Jahi McMath should remind us—bioethicists included—that it’s a lot more complicated now.

References:

Bloomekatz A. ‘Inevitable’: As Jahi McMath deteriorates, brain-death case nears end. Los Angeles Times. January 9, 2014. Retrieved from http://www.latimes.com/local/lanow/la-me-ln-jahi-mcmath-body-deteriorating-20140108,0,4831276.story#axzz2q1QnqUkl

Editorial: Let Marlise Munoz die. Dallas News. January 9, 2014. Retrieved from http://www.dallasnews.com/opinion/editorials/20140109-editorial-let-marlise-munoz-die.ece

Szabo L. Ethicists criticize treatment of teen, Texas patient. USA Today. January 10, 2014. Retrieved from http://www.usatoday.com/story/news/nation/2014/01/09/ethicists-criticize-treatment-brain-dead-patients/4394173/

Tomlinson T. Misunderstanding death on a respirator. Bioethics. 1990;4(3):253-264. Retrieved from http://onlinelibrary.wiley.com.proxy1.cl.msu.edu/doi/10.1111/j.1467-8519.1990.tb00088.x/abstract

Truog R.D. Is It Time to Abandon Brain Death? Hastings Center Report. 1997;27(1):29-37. Retrieved from http://www.jstor.org/stable/3528024

tomlinsonTom Tomlinson, Ph.D., is the Director of the Center for Ethics and Humanities in the Life Sciences and a Professor in the Department of Philosophy at Michigan State University.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, February 6, 2014. With your participation, we hope to create discussions rich with insights from diverse perspectives. You must provide your name and email address to leave a comment. Your email address will not be made public.

Bioethics Brownbag & Webinar Series Special Event: Professor Masahiro Morioka lecture

The Center for Ethics has partnered with the Department of Philosophy and the Asian Studies Center to welcome Masahiro Morioka, Professor of Philosophy and Ethics at Osaka Prefecture University in Japan, for a special lecture in the Bioethics Brownbag & Webinar Series.

Professor Morioka is considered to be one of the most influential thinkers in Japanese philosophy and sociology. He is the director of the Research Institute for Contemporary Philosophy of Life at Osaka Prefecture University, and is the editor-in-chief of the Journal of Philosophy of Life. He specializes in philisophy of life, life studies, bioethics, gender studies, and criticism of contemporary civilization.

Brain Death, the Concept of  ‘Persona,’ and the Principle of Wholeness

Japan is a country where unique discussions on brain death take place not only among specialists but also lay persons. Using narratives, Professor Morioka will present his theories on some philosophical aspects of brain death, that is to say, the concept of ‘persona’ and the principle of ‘wholeness.’

Join us for Professor Morioka’s lecture on Friday, September 28, 2012 from noon till 1 pm in person or online:

In person: The lecture will take place in the International Center on MSU’s East Lansing campus, in Room 303. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Event flyer: BB_Webinar ad morioka event 12_13